HomeMy WebLinkAboutGW1-2022-10673_Well Construction - GW1_20221128 i
-WELL.CONS'TRucriON RECORD Fur[etsrnal Usc ONLY:
' 'Phis form can be nsc6 fol.siugTc or tmiltipk acIIs` f
L�Vclt,Conti:ieNrLlforlltatlon:
John Eisenman FROM-. TCI DtwSCRIPTION
1%'eflCotlAiacttirNtmC R: ft. � f
4439 IL ft: l
NC Well CorulaclorCcilifiralionNurke IS OUTFR CASING(toi muHi rived�cilsl''OR LINERIIT:a`" tlea�tc); .:.. _
FROM TO DTAMF.TER' THIMMESS MATERIAL
SAEDACCO Inc (4. fL: ',
Cnniq,roq=N;kuiC- I6 INN OR=TUDDR r. i5oi`eiiif5l"eruscildaoj►``' _.
FROM TO - DLALNIFT13R I TnICIut'ESS I MAT•ERLkL
2:Well Constriction Vomit i. 0 R. 5 It. 2" i •hL SCH-40 PVC
Lisr'ir!lrrppilicaiSle rscll pr'uRih fi_c.Cnmuy.'Sta!r.,Yarinmrr.Irlfet0?+}ct�:J''
3.Nell 15 (cheekwell 05c); rI7:SCRMN
Wester Supliky MlC11: FROM To I DWAIRTF,rt SLOTSI7.G TTIICXNMS MATRWAL
Chlglicul[igal Clltifi►DicipaUPnblic 5 ft. 20 R•' 2" in .010 SCH-40 PVC
®t leDtli nual(Iieati4cooling Siglply) EIResidentiat Niter 5uOly,(single) ft. ft ;n
®Yndu9trLWComnterci6l ®Residential NVatsr,5upp1}'(sLvired) t13.CR0[iT . • :_-,_
FR03I TO. tIATERIAI EMPLAC'EhnNTAIMOD&AMOINIT
El hTipation 0 :R. 3 f4 .Portland Pour
N6u-water Supply}VglB:
-
6JManihirinG f�Rccp�•cty
Injecllun�Vclt• _ rI. r4.
C1AgtirferRecliRrgc Wrtoutid%%nlctReine(tialiau. ts1S tNDr�R oust rAcrrrr• '1 at�nute)" _ _=-_.-. .-.
•WIIOSI TO - VATFR(AL RS1PL4(,Z%1FNT.ML'TH0D
l7Agaifcr.Sto[agc and RccQvc1 ❑Salinily 8"Odcr, q R. 21 ft. Sind? ' #2
0Aguifci116cst C]51oiTiiii�ttcrl}riinoSc ft.. f4
O �glCitmcntal Tcclmologp. 6sdiict>,cc`CoiruJT
n2tl:DftFLEbl1G'I:oG7atiaek"addliional'sficetsif ricecs`snn4
�ti:wtIl nual.('Clasen Loop) OTracer FROM•- TO DGSCRIPTID:C(Polir.hnrdncn.eut0.h+Kk 'nsrattel
l7(_,oatl,enn&i'(Heatii! CuolingReWill) l3011ter(explain Malec0I-Remolbs) ty to
l R'al Eb#MW-3R f4 tt
5a:WWII Li►catlDne f4 f4 '
Mills Cleaners f4 ft
Faci]ily101cocrNnlue FagilHj•Il)ra�E applicable), tfis•''
1305 Skyway Dr., Monroe, NC, 28110 It.. f4
Pllysr id ildd�csS City_and Zip <2i:Henthticc5 .
Union Bentonite seal from 3-4'
Con,uy tared W11015a;1110u No.(PIN)
5ti;.1 atitudeanil G ngitu cEn iEcgisc#W/ utcs/sicnnilsa' dceimul:it Icss: 22:Certification-
Ot&%ell freW:ow 1,10ow"1$it icierd)
lY W '-L' 11/6/2022
6.Is(:ire)t(le wdlOt SlPennancut oir Memporary �v fa
By 4noig,roirlat,� r �!� ifu M :rn• , .a r'j.`,:cis=,Lgnq114arvd rr mvvir rr
mtrh'l5,11PGtG 02C x �..t ',Gre: WZ47,02M Well Carrstirteriva grarklanis mld rlutr�l
7.to thLr a ire;raii•to an exiStin;;%t'elli EJYt�r iir ®ND coprpojrhAr�rr6ryf kris lxen liiz+i trlyd ro ilre slr!!rnvrier.
tjrhls'ls n rrejhrlr ill W kr(Aivi I ill c�aai7ruclio®lnfgnnnrtotr�IreJ�iptpin(he Wrure ojrhe I
rerirrir mut.rr,lSl:rcvncerk`v rertrun p on the t!rirC oJtldr .forne 23:$Ete.1111rR m-or add1dqua1 well detidli:
You may.nip de back of Uiis p7ge io proride'addiUotiat%cell site dkatsl or%sell
8:14uRtberof ivclis irotislntMed: 1 cousutiction delails. You nia$also der!additioluil paiNs if fiecessaw
Forirru(rlpleh�ecifi?!Iarnrul-n+u;ersupplyweff��J,tiLYirlrli'rhu.srrnrecoaes(ruefiou,g�,vtrcv�rt .''
rdintirorirjorrra. SLIBNFITT'tGfNS`1 M®N3
9:4ota!ivelE depth beioif land stirfaei: 20 Fiir All Wah Snbinit dds forlii withiri 30 doys of completion of well
Forircul!lpleicillsl�srrrlldryrltsifdl�errila(cxarnpfr-3@20Ct'aiif.2ksl constnictionto the tbl[aning;.
IU.Static%voter lad 6cluw top of slum%; (ly,) IlMsinn nf'�VAter Rciaurc6i,Information Pmcessin;Unit,,
arse 1,+1Jnriier lc%al ie aLoec cviela�, IG17 Maii.Siti iCc;Cctitcr,ILrli igh}vC 2764J-IGL7
II llorchOlc diamcter,8 25'� (in.) 14b. •n•100419a!Nglb ONLY: 3ti addition to•seading,flw fomi to be address in
24$ak&vL also sublilit a,-copy of iliis fanit within 30 da);s'of completion of i%ell
ILWclleoustnictloll Method:HSA Lousinicacatothe, foll6%6,Lp,!
(i.c.augec•tnlar)',cable,direct FDsI►,etc:)
Aw6lott amater itesou t'ces,Vu6rgrouud[njec(Ion Captiol_Program,
FOR WATER SUPPLY WELLS ONLY., 1636 AI,t1!Service,Center,Raleigfi,N1C 27699.1636
13,.4 Field(*u) tTcCi,orl of test: dc..lFor%Vato it Su pir it IMtetlon�etls:.
Also submit one cop}' of this fdnii Within 30'da3's of cotupletion of
13b.DINInfectiun,ttjW Amount: %%zll c'n4niction to ft county bcalth dgmrimcnt of the coitnh Whel>
commictt d.
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